Optical coherence tomography of macular lesions associated with optic nerve head pits
Optical coherence tomography of macular lesions associated with optic nerve head pits
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DOI：
10.1016/s0161-6420(96)30568-x
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发表时间：
1996-07-01
期刊：
影响因子：
13.7
通讯作者：
Cox, MS
中科院分区：
文献类型：
--
作者：
Rutledge, BK;Puliafito, CA;Cox, MS
目的：虽然视神经窝在一个多世纪前就被描述了，但其相关黄斑病变的发病机制和病理性质仍然存在争议。作者利用光学相干断层扫描（OCT）技术进一步明确了光学凹坑、黄斑裂片样间隙和黄斑脱离之间存在的解剖关系。方法：对连续3例视神经窝相关性黄斑病变患者的4只眼进行评价。横断OCT图像与裂隙灯生物显微镜和立体眼底摄影结果相关。所有的眼睛以前都进行了不成功的光凝到颞乳头旁视网膜。1眼行玻璃体切除及眼内气体填塞，导致黄斑下积液部分吸收移位。结果：四眼均有视网膜水肿和囊性变性，黄斑神经感觉脱离。最显著的水肿出现在外视网膜外丛状层水平。这模拟了一个真正的视网膜裂腔，尽管桥接的视网膜元素是可识别的。内视网膜有轻度水肿，主要位于椎间盘和中央窝之间。在一只眼睛中，一个板层洞被证明是外部神经感觉视网膜的缺陷。在另一只眼睛中，黄斑脱离发生在原有的裂片样腔下。裂片样腔或视网膜水肿与视盘相通，而黄斑脱离与视窝之间没有直接联系。结论：这些发现支持双层结构的概念，其中黄斑脱离继发于先前存在的裂片样病变，包括严重的视网膜外水肿。液体可能从视坑进入视网膜基质，而不是直接进入视网膜下间隙，这解释了光凝治疗乳头旁视网膜后恢复时间长和治疗失败的频率。
Purpose: Although optic pits were described more than a century ago, the pathogenesis and pathologic nature of the associated macular lesions remain controversial. The authors used the technique of optical coherence tomography (OCT) to further define the anatomic relation that exists between optic pits, macular schisis-like spaces, and macular detachments.Methods: Four eyes of three consecutive patients with optic pit-related macular pathology were evaluated. Cross-sectional OCT images were correlated with findings from slit-lamp biomicroscopy and stereo fundus photography. All eyes previously had undergone unsuccessful photocoagulation to the temporal juxtapapillary retina. One eye had undergone vitrectomy and intraocular gas tamponade, resulting in partial resorption and displacement of the submacular fluid.Results: Retinal edema and cystic degeneration were present, overlying macular neurosensory detachments in all four eyes. The most prominent edema was present in the outer retina at the level of the outer plexiform layer. This mimicked a true retinoschisis cavity, although bridging retinal elements were identifiable. A lesser degree of edema was present in the inner retina, predominantly located between the disc and fovea. In one eye, a lamellar hole was shown to be a defect in the outer neurosensory retina. In another eye, a macular detachment developed under a pre-existing schisis-like cavity. The schisis-like cavity or edematous retina communicated with the optic disc in all eyes, whereas none of the eyes demonstrated a direct connection between the macular detachment and optic pit.Conclusion: These findings support the concept of a bilaminar structure in which a macular detachment develops secondarily to a pre-existing schisis-like lesion consisting of severe outer retinal edema. Fluid may enter from the optic pit into the retinal stroma and not directly into the subretinal space, explaining the prolonged recovery and frequency of treatment failure after photocoagulation to the juxtapapillary retina.